Provider Demographics
NPI:1245321405
Name:COUNTY OF JEFFERSON
Entity type:Organization
Organization Name:COUNTY OF JEFFERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:TWEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-863-2278
Mailing Address - Street 1:1250 WALNUT
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066
Mailing Address - Country:US
Mailing Address - Phone:785-863-2278
Mailing Address - Fax:785-863-3145
Practice Address - Street 1:1250 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066
Practice Address - Country:US
Practice Address - Phone:785-863-2278
Practice Address - Fax:785-863-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS870341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089340DMedicaid
KS005882OtherBCBS PROVIDER NUMBER
KS410300Medicaid
MO805808508Medicaid
KS100089340DMedicaid
KS410300Medicaid
KS626128Medicare ID - Type UnspecifiedTRIGON PROVIDER NUMBER